Browse > Article

Lower Eyelid Full-Thickness Reconstruction Using a Radial Forearm Free Flap with Palmaris Longus Tendon Sling: A Case Report  

Kim, Tae Hoon (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
Eun, Seok Chan (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
Baek, Rong Min (Department of Plastic and Reconstructive Surgery, Seoul National University College of Medicine)
Publication Information
Archives of Craniofacial Surgery / v.12, no.1, 2011 , pp. 48-52 More about this Journal
Abstract
Purpose: Many advances have been made in lower eyelid reconstruction surgical procedures after tumor ablative therapy. These include skin grafts, local flaps, free flaps, and skin expansion. When a full-thickness defect of the lower eyelid is reconstructed with many free flaps, ectropion and deformity of the medial and lateral canthal areas are common late complications caused by gravitational descent. The radial forearm free flap is widely used because of its lack of bulk, ease of dissection, malleability, and hairlessness. This report introduces a novel method for preventing ectropion using a composite radial forearm free flap reconstruction and palmaris longus suspension technique. Methods: A 70-year-old man had a malignant melanoma on his left lower eyelid. The patient was referred to our department after a biopsy confirmed the initial diagnosis. A full-thickness wide resection with a 25 mm free margin was performed, and a $5{\times}8cm$ radial forearm flap was elevated with a vascularised palmaris longus tendon. The palmaris longus tendon was fixed to the medial and lateral orbital rim perisoteum and the deep temporal fascia. The buccal mucosa was grafted to reconstruct the inner conjunctival layer. The pedicle vessels were anastomosed to the left superficial temporal artery and vein. Results: The postoperative clinical course was uneventful. The flap showed good texture and color match. No ectropion was noted 14 months after surgery and the tumor did not recur. The patient was quite satisfied with the final outcomes. Conclusion: Use of a radial forearm free flap and the palmaris longus tendon is an effective method for a full-thickness lower eyelid reconstruction.
Keywords
Lower eyelid; Malignant melanoma; Radial forearm flap; Palmaris longus;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Kaufman AJ: Reconstruction of a large surgical defect involving the lower eyelid and infraorbital cheek. Dermatol Surg 29: 284, 2003   DOI   ScienceOn
2 Bae YC, Kim SH, Hwang SM, Kim KT, Oh CK: Reconstruction of the lower eyelid with septal mucochondral composite graft and upper eyelid musculocutaneous flap. J Korean Soc Plast Reconstr Surg 31: 309, 2004
3 Zaccagna A, Raiteri E, Picciotto F: Repair of a large surgical defect involving the lower lid, cheek, and temporal region. Dermatol Surg 29: 182, 2003   DOI   ScienceOn
4 Mathijssen IM, van der Meulen JC: Guidelines for reconstruction of the eyelids and canthal regions. J Plast Reconstr Aesthet Surg 63:1420, 2010   DOI   ScienceOn
5 Ogawa T, Nakayama B, Hasegawa Y, Fujimoto Y, Kohmura T, Matsuura H, Miyata H: Treatment of malignant melanoma of the lower eyelid using anterolateral thigh flap. Auris Nasus Larynx 27: 79, 2000   DOI   ScienceOn
6 Rampazzo A, Gharb BB, Chen HC: Total lower eyelid reconstruction with free posterior auricular chondrocutaneous flap. J Plast Reconstr Aesthet Surg 63: e384, 2010   DOI   ScienceOn
7 Daya M: Simultaneous total upper and lower lip reconstruction with a free radial forearm-palmaris longus tendon and brachioradialis chimeric flap. J Plast Reconstr Aesthet Surg 63: e75, 2010   DOI   ScienceOn